Abstract

Adenotonsillectomy is a type of surgery that is among the most popular in the pediatric surgical field and has to be managed with a thorough approach to the anesthetic to reduce the number of possible complications and enable quick healing. Ketamine combined with propofol (Ketofol) has become of interest because it has the potential to deliver balanced anesthesia, sufficiently effective analgesia, and cardiovascular stability, but there is limited evidence on its efficacy and safety in adenotonsillectomy in children. A systematic literature search of PubMed, Scopus, Web of Science, and Cochrane Central was conducted until January 2025 to detect randomized controlled trials comparing Ketofol and propofol or saline in children experiencing adenotonsillectomy or tonsillectomy. The synthesis of data was conducted with a random-effects model, and the effect estimates were presented as mean differences and risk ratios with a 95 percent confidence interval. A total of four randomized controlled trials that comprised 497 children aged 3 to 15 years were included. Ketofol was not found to have a significant difference over propofol in terms of minimizing emergence delirium (RR = 0.98, 95% CI 0.59–1.64), recovery time (MD = -0.53, 95% CI -3.87 to 2.82), or time to discharge (MD = -1.07, 95 percent CI -3.41 to 1.28). Ketofol, on the contrary, had much higher cardiovascular stability than saline, indicated by the lower value of heart rate (MD = -9.14, 95% CI -11.21 to -7.07). In general, Ketofol seemed to be a safe and efficacious anesthetic in pediatric adenotonsillectomy as propofol and had better cardiovascular stability than saline.

Key words: Adenotonsillectomy, anesthesia, ketofol, propofol, sedation, systematic review.